Blood Transfusion Therapy and Nursing Care Practice Questions
20 free Blood Transfusion Therapy and Nursing Care practice questions for the NCLEX Exam. Tap an option to answer — you get instant feedback, the correct answer, and a detailed explanation for every question.
Before initiating a blood transfusion, what should the nurse's first action be?
- A Hang the blood product and begin infusing it rapidly
- B Verify the physician order and obtain informed consent
- C Give pre-medications after the first 15 minutes of transfusion
- D Begin transfusion, then check vital signs after 30 minutes
Correct answer: Verify the physician order and obtain informed consent
Before starting a transfusion, the nurse must verify the order and ensure informed consent is signed as part of safe practice.
What is a critical safety step just prior to administering a unit of blood?
- A Warming the unit rapidly in a kitchen microwave
- B Two licensed staff verify patient ID, type, and unit number
- C Starting the transfusion without an inline blood filter
- D Using D5W solution to prime the transfusion tubing
Correct answer: Two licensed staff verify patient ID, type, and unit number
Two-nurse verification of patient ID and product details is essential to prevent ABO/Rh incompatibility reactions.
How long should the nurse monitor vital signs after initiating a transfusion?
- A 5 minutes
- B 15 minutes
- C 30 minutes
- D One hour
Correct answer: 15 minutes
Most transfusion reactions occur within the first 15 minutes, so staying with the patient during this period is key.
Which intravenous fluid is compatible for priming and flushing the blood administration set?
- A D5W (5% dextrose in water)
- B Normal saline (0.9% NaCl)
- C Lactated Ringer’s
- D Half normal saline (0.45% NaCl)
Correct answer: Normal saline (0.9% NaCl)
0.9% normal saline is the only fluid typically recommended for priming or flushing tubing in blood transfusions to avoid hemolysis or coagulation complications.
What is the maximum time a unit of red blood cells should hang from start to finish?
- A 1 hour
- B 2 hours
- C 4 hours
- D 6 hours
Correct answer: 4 hours
Blood products are typically required to be transfused within 4 hours of initiation to reduce risk of bacterial growth and ensure safety.
When a patient develops dyspnea, cough, hypertension, and jugular vein distension during a transfusion, what reaction is suspected?
- A Acute hemolytic transfusion reaction from incompatibility
- B Transfusion-associated circulatory overload (TACO)
- C Septic transfusion reaction from a contaminated unit
- D A mild allergic reaction with urticarial features
Correct answer: Transfusion-associated circulatory overload (TACO)
Signs like dyspnea, cough, JVD and hypertension during transfusion point to volume overload (TACO) rather than hemolysis or simple allergy.
What should a nurse do if a patient's pre-transfusion vital signs show Temp 100.2 °F, HR 98, BP 110/70?
- A Proceed with the transfusion without further concern
- B Cancel the transfusion for fever and notify provider
- C Start the transfusion immediately as scheduled
- D Warm the blood product before hanging the unit
Correct answer: Cancel the transfusion for fever and notify provider
A fever ≥100.4 °F or signs of infection may indicate risk for transfusion complications; some protocols require provider notification and assessment before proceeding.
In the event of an acute hemolytic transfusion reaction, what is the first nursing action?
- A Decrease the transfusion rate to roughly half
- B Stop the transfusion, run normal saline, and notify provider
- C Continue the transfusion and administer antihistamines
- D Remove the IV line and await provider instructions
Correct answer: Stop the transfusion, run normal saline, and notify provider
In a suspected hemolytic reaction, immediate stoppage, saline infusion and alerting provider are essential to prevent further harm.
Which patient is at greatest risk for a transfusion reaction requiring very slow infusion rate?
- A A healthy 20-year-old female blood donor
- B A 75-year-old man with chronic heart failure
- C A fit 30-year-old competitive endurance athlete
- D A 40-year-old adult with no known comorbidities
Correct answer: A 75-year-old man with chronic heart failure
Patients with heart failure are at higher risk of volume overload and thus require slower transfusion rates.
During a transfusion, if a patient complains of itching and develops hives but is hemodynamically stable, what should the nurse do?
- A Continue the transfusion at the same infusion rate
- B Stop the transfusion and treat as an allergic reaction
- C Increase the rate to finish the unit more quickly
- D Switch to saline only and then resume the transfusion
Correct answer: Stop the transfusion and treat as an allergic reaction
Development of urticaria and itching signals a possible allergic transfusion reaction; the transfusion should be stopped and treated accordingly.
Which blood product is most appropriate for a patient with active major hemorrhagic anemia needing oxygen‐carrying capacity?
- A Platelets
- B Fresh frozen plasma
- C Packed red blood cells
- D Cryoprecipitate
Correct answer: Packed red blood cells
Packed red blood cells increase hemoglobin/oxygen‐carrying capacity, making them appropriate in hemorrhagic anemia.
How should a nurse approach a patient who refuses transfusion for religious reasons?
- A Force the transfusion since the physician ordered it
- B Respect the refusal and document discussion and alternatives
- C Disregard the refusal and proceed with the transfusion
- D Remove the patient's IV access without delay
Correct answer: Respect the refusal and document discussion and alternatives
Patients have the right to refuse treatment; the nurse must respect the decision, provide education about risks, document the discussion, and explore alternatives.
After the transfusion is complete, what post-transfusion monitoring is appropriate?
- A No further monitoring of the patient is needed
- B Obtain vital signs, watch for delayed reactions, document
- C Only inspect the peripheral IV insertion site
- D Only ask the patient whether they feel well
Correct answer: Obtain vital signs, watch for delayed reactions, document
Post-transfusion care includes vital signs, monitoring for delayed reactions and proper documentation of the transfusion.
Which signs during transfusion suggest a febrile non-hemolytic transfusion reaction?
- A Rapid-onset hypotension with severe lower back pain
- B Fever over 1 °C above baseline, chills, and headache
- C Severe diffuse itching with widespread urticaria
- D Immediate central cyanosis with audible wheezing
Correct answer: Fever over 1 °C above baseline, chills, and headache
Febrile non-hemolytic reactions are characterised by fever and chills due to cytokines, and unlike hemolytic reactions do not typically show immediate hemolysis signs.
What care adjustment should the nurse make for a patient with renal failure receiving a blood transfusion?
- A Transfuse at the standard rate regardless of status
- B Monitor for fluid overload and transfuse cautiously
- C Use D5W instead of saline for priming the tubing
- D Remove the blood warmer device before starting
Correct answer: Monitor for fluid overload and transfuse cautiously
Patients with renal impairment are at increased risk of fluid overload; the transfusion rate should be slower and closely monitored.
What is the correct statement about the Y-type blood administration set?
- A It removes the need for any saline flushes entirely
- B It permits saline flush through one limb while blood runs
- C It is intended for platelet transfusions only
- D It allows mixing of two blood groups in one line
Correct answer: It permits saline flush through one limb while blood runs
A Y-type set allows normal saline to be administered concurrently or used for priming/flushing along with blood through the other branch.
If a unit of red blood cells was released from the blood bank 45 minutes ago and remains at room temperature, what should the nurse do next?
- A Begin the transfusion immediately without delay
- B Return the unit to the blood bank if past the time limit
- C Warm the blood with a fluid warmer and hang it
- D Prime the line with D5W and start the infusion
Correct answer: Return the unit to the blood bank if past the time limit
Most facilities require blood to be transfused within a specified time (commonly < 30-45 minutes from release) to reduce the risk of bacterial growth; if not hung within that time, it must be returned.
When a patient suddenly develops hypotension, chest pain, and dark urine during a transfusion, what reaction is most likely?
- A Allergic reaction
- B Transfusion-associated circulatory overload
- C Acute hemolytic transfusion reaction
- D Febrile non-hemolytic reaction
Correct answer: Acute hemolytic transfusion reaction
Hypotension, chest/back pain, and dark urine following transfusion suggest acute hemolysis (destruction of donor RBCs) and requires immediate intervention.
When a patient post-transfusion presents crackles at lung bases, increased BP, and shortness of breath, what should the nurse do?
- A Speed up the transfusion so it finishes quicker
- B Stop the transfusion and assess for fluid overload
- C Administer epinephrine and continue the infusion
- D Continue the transfusion since the signs are mild
Correct answer: Stop the transfusion and assess for fluid overload
These signs point to volume overload; stopping the transfusion and assessing for transfusion-associated circulatory overload is required.
What key nurse teaching should be given to a patient about to receive a transfusion?
- A You may stop the transfusion yourself at any time without telling staff
- B Report unusual sensations like chills, itching, chest pain, or trouble breathing
- C There is no need to discuss your previous transfusion history with the team
- D It is acceptable if the donor blood does not exactly match your blood type
Correct answer: Report unusual sensations like chills, itching, chest pain, or trouble breathing
Patients must be informed to report early signs of transfusion reaction (e.g., chills, itching, chest pain, dyspnea) so prompt intervention can occur.